The High Cost of Nurses’ Communication Challenges

Achieving better quality care through a more efficient and effective workforce is a global imperative in healthcare. Electronic health records (EHRs) are the preferred solution for improving patient safety and reducing duplicate tests and procedures, yet the increasing focus on them masks a potentially powerful and immediate remedy to healthcare’s ailments.

There is an opportunity for better, easier communication and collaboration among the roughly 1.3 million Canadian healthcare professionals, especially clinicians – who represent one third of the workforce inside health systems.

A recent study conducted by Zogby International (2010 National Survey of Hospital Nurses) identifies the impact of communication challenges facing nurses and revealed that easier, more effective communication and collaboration positively impacts health system performance—not only patient safety, but also clinician efficiency, healthcare costs and patient satisfaction.

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The study shows that an inefficient communication and collaboration infrastructure have had a detrimental impact on direct and indirect costs, including time management- specifically lost time resulting from the process of locating other people for information, searching for supplies, resources etc.

In addition, nurses face a digital divide— with fewer than half using communication technologies with features needed to work effectively. Hospitals that support nurses with technologies to communicate, locate other clinicians and patients, and quickly track supplies will realize the greatest improvements in productivity and quality.

Together, health system leaders, technologists and solutions vendors must work in partnership with nurses to design and implement communication solutions—integrated with clinical applications—that give them more time at patient bedsides and the ability to work effectively with all members of a care team, resulting in a more personalized care experience for each patient and family member.

Survey Overview

Two hundred and fifty-three practicing nurses—representing disciplines as varied as medical-surgical, emergency room, operating room, and critical-care services— participated in the study. Conducted the first quarter of 2010, the survey illuminates the costs of communication lapses on patient care and the overall ability of nurses to do their jobs. Highlights from the survey include:

82 percent indicated that common communication hurdles have a “high to very high” impact on their ability to work efficiently.

60 percent estimated working up to 10 hours of overtime each week resulting from time wasted trying to locate patients and communicate with staff-as much as 2 hours per shift.

56 percent identified the tracking of a patient location and their overall status as the most important information needed at the point of care.

From the perspective of technology-investment planning, the above findings demon¬strate a clear need to balance investments in clinical systems such as computerized physician order entry (CPOE) and EHRs with investments in communication solutions. In fact, hospitals without CPOE and EHR systems may improve patient safety more quickly by prioritizing investments in communication/collaboration technologies.

For hospitals that already have clinical applications in place, communications technologies yield meaningful incremental improvements in patient safety and quality and show an impact across multiple business priorities, compared with clinical systems that may address only one care process, such as the administration of medicine.

Tracking and Locating Supplies

Nurses lose significant amounts of time searching for hospital resources. Eighty-five percent of respondents reported spending as many as 60 minutes per shift searching for supplies, such as wheelchairs and infusion pumps.

Hospitals focused on improving productivity should consider implementing location-tracking solutions integrated with nursing communications devices. Hospitals that provide nurses with technologies for communicating with team members, locating other clinicians and patients, and tracking supplies will generate the greatest productivity improvements.

Patient Safety and Quality of Care Are Impacted Equally

When asked to describe the impact of job-related communication lapses, 77 percent said impact on patient safety is “high to very high.” Nurses are looking for specific features in communications devices to support improved patient care. Closed-loop confirmation was the second-most-important feature (following extended battery life), with 94 percent listing closed-loop as a “nice-to-have” or “must-have” feature. Interoperability with clinical applications was the third-most-desired feature.

Impact on the Patient Experience

The survey highlighted another topic of importance to nurses and CXOs, the patient experience. When asked to rate the potential impact of improved communications on the patient experience, 74 percent of nurses noted a “high to very high” impact. In addition, “more timely patient care” was the second-highest-ranking response when nurses were asked, “If a nurse’s communications device could help you overcome one key work challenge, which one would have the greatest positive impact?” Patient satisfaction is emerging as both a competitive differentiator for health systems and a factor impacting fiscal support. In addition, many leaders across the healthcare industry now acknowledge that consumers define clinical quality based on their perception of the care experience.

Nurses Face a Digital Divide

Despite the communications-intensive nature of patient care, 25 percent of nurses surveyed reported having no access to a mobile communications device. Other nurses reported using multiple mobile devices that do not interoperate.

Of the nurses surveyed, 91 percent said they would like a single communications device to meet their needs, but only 41 percent reported actually using a single device. Another 27 percent said they use two devices during a typical shift.

When asked about their preferred communications device, more than half (57 percent) of the respondents said they prefer a device that provides voice, while 38 percent said they prefer one that provides text.

Their responses raise several interesting implications for hospital managers and tech-nology vendors. Devices that are more similar to phones than to PCs are a better choice. Great attention has been paid to making PCs easily accessible to staff in patient-care units, but the survey suggests that “computers on wheels” and other full-screen PCs may be needed only when access to a complete clinical record is necessary. In fact, almost half of the nurses surveyed said that having a screen size similar to that of the average laptop computer is unnecessary.

These findings may indicate that nurses need immediate access to specific information more often than they do for comprehensive reports and records. There is a clear opportu-nity for IT vendors to provide text-to-voice technologies, in addition to the current genera¬tion of voice-to-voice and voice-to-text solutions.

The Need for IT Integration

One question best illustrates a theme found throughout the study—specifically, the need to integrate applications (clinical and administrative) with technologies such as radio frequency identification (RFID) and “presence” into a single mobile communica¬tions device. Responses to this question are highlighted below:

Information Needed

Patient location and status

Care team availability and location

Patient lists (coverage)

Room availability

On-call directory

Map showing location of equipment

Other*

Not sure

Percentage of Respondents

56

48

39

32

29

13

13

17

Conclusion

Significant improvements in the performance of nurses hospital-wide are possible when the barriers to easy, collaborative nursing communications are broken. This study, and others, provides a call to action for health system leaders, technologists and solutions vendors to work in partnership with nurses. Together, such partnerships can develop and deploy communication solutions tailored to nurses’ unique needs. Well-designed solutions incorporated into nursing practice promise greater efficiency, improved quality, and more satisfaction among patients and nurses.

Appendix A: Survey Methodology

A sample of participants from Zogby International’s online panel, which represents the adult population of Canada, was invited to participate in the survey from February 20, 2010 to March 10, 2010. The margin of error is ± 6.2 percentage points. Margins of error are higher in subgroups.